1. Field of the Invention
The present device relates to a surgical apparatus, e.g. , for applying surgical staples to body tissue and to attach objects to body tissue. More particularly, the device described herein is preferably useful in minimally invasive surgical procedures and provides advantageous articulating features.
2. Background
Surgical repair of body organs an tissue often requires the application of surgical fasteners. In some instances, the fasteners used are in the form of two part fasteners and in other instances, they are unitary metal staples. Such metal staples are used in numerous types of body tissue repair including such procedures as chest wall reconstructions, tram flap procedures, hernia repairs, etc. In most surgical repairs, the staples are applied directly to the body tissue requiring attachment or reattachment. In certain other procedures, the staples are used to attach an intermediate object to the body tissue. One such example is the application of surgical mesh to body tissue which is often used in hernia repairs.
For example, the surgical repair of hernias is generally confined to the lower abdominal and groin areas of the body, involving repositioning reattachment of the herniated portion of the abdomen using surgical staples or sutures. Developments in minimally invasive surgical procedures, such as laparoscopic and endoscopic surgery, have enabled surgical procedures to be performed in certain confined areas. In addition, surgical repairs involving other body parts or organs have also benefitted from laparoscopic and endoscopic advances.
Minimally invasive surgical procedures involve the deployment of instrumentation through small openings in a wall of body tissue. This type of surgery is highly advantageous because trauma to the patient is substantially reduced, which also reduces recovery time, costs, and the risk of post-operative complications. For convenience, as hereinafter used the term "endoscopic" shall refer generally to all types of minimally invasive surgical procedures, including laparoscopic procedures.
An endoscopic instrument is one which provides the facility for a surgeon to operate at a site in the interior of a patient's body while actuating the instrument exterior to the body. Endoscopic instruments have a relatively long endoscopic portion which is sufficiently narrow to be inserted through a trocar cannula or small entrance incision in the skin. An operating portion is positioned at the distal end of the endoscopic portion and may include such devices as clip or staple appliers, graspers, tissue movers, and the like. Actuation of the instrument is accomplished outside the body, remote from the operating site. Typically, the endoscopic instrument has a non-endoscopic handle portion having actuators such as triggers, push buttons, rotary dials, and the like. In the endoscopic portion of the apparatus, movement of internal working members, such as drive rods, camming members, and the like is generally constrained to linear motion along or parallel to the longitudinal axis of the instrument, or to rotation around the axis. The distal operating portion may additionally have some lateral component or motion, such as, for example, the jaws which pivot laterally to open or close. Typically, there must be a fluid seal within the apparatus and between the apparatus and cannula to prevent entry or egress of fluids. This is especially true in abdominal surgery wherein the abdominal cavity is insufflated with a gas. Sealing can be provided by having close tolerances between moving parts, or by having sealing members.
One elongated surgical stapler for endoscopic applications is described in commonly assigned U.S. patent application No. 07/950,425, filed on Sep. 21, 1992 now abandoned which is incorporated herein by reference. The aforesaid elongated surgical stapler comprises frame means, generally elongated endoscopic means, means for storing a surgical staple, means for individually advancing the staple distally, and anvil means for closing the staple to engage the staple into body tissue.
Non-endoscopic hernia procedures may also entail surgery in the confined areas of the lower or upper abdomen. Instruments which are relatively short in length may be utilized for direct insertion into the lower abdomen through surgical incisions. It would be advantageous to provide a surgical stapler whereby the distal end of the stapler articulates relative to an axis of the stapler after the stapler is inserted for extending the distal end around bones, body tissue, and the like to orient and apply surgical staples from the distal end into body tissue. These staples could be applied directly to body tissue or for attaching objects such as mesh to body tissue.
Therefore, a need exists in many such procedures for a compact surgical stapler having an articulating distal end for accurately positioning and securely attaching surgical staples to body tissue. In addition, the articulation mechanism should provide a stable articulated position at the distal end, allowing the distal end to be set in a fixed orientation by the operator, freeing the operator's hands for other activities.
Moreover, it would be highly advantageous for the handle portion to articulate as well. Articulation of the handle portion would provide for adaptability to accommodate different methods of holding and handling the apparatus during operation and would be a great convenience to the operating personnel.